| NPI | 1053088179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61179593) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P9511) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2024-07-18 |